Maternal Child Health and Nutrition (MCHN)

Maternal Child Health and Nutrition (MCHN) Programme:
Maternal, Child Health and Nutrition (MCHN) services have received substantial international attention and are high on global health and development agendas. Investing in MCHN is thus recognized as contributing to poverty reduction, economic growth and productivity, and more stable societies. In this project, CMC therefore aims at improving access to quality Maternal, Child Health and Nutrition (MCHN) services; reduce neonatal and maternal mortality rates, which also include disability rates; and to reduce the incidence, impact and severity of malnutrition amongst children domiciled in South Sudan.

More than 50% of the South Sudanese population lives below the poverty line, with particularly high levels of poverty in rural areas (South Sudan National Bureau of Statistics, 2012). This is comparable with the SSA average of 47% of people living on less than $1.25 a day (UN, 2012). The adult literacy rate in South Sudan is also low at just 27% (53% urban areas and 22% rural areas) with the rate among females half that of males (South Sudan National Bureau of Statistics, 2012). Minimal progress has been made toward meeting the SDG targets. The government of South Sudan is working toward achieving these goals. Maternal, newborn, and child mortality indicators used for monitoring progress toward the achievement of SDG-3.8 remain high.

In South Sudan, nearly 7% of women aged 15 to 49 marry before their 15th birthday, a substantial reduction from 16.7% in 2006. However, 45% still married before the age of 18 in 2010, which is an increase from the 2006 average of 41% (MoH & National Bureau of Statistics, 2013). Young women experiences exacerbated problems during pregnancy and delivery due to incomplete body growth, and are particularly at risk of obstetric fistulae and obstructed labor.

In 2010, the average rate of contraception use for women married or in union in South Sudan was 4%, only 0.5% higher than in 2006 (MoH & National Bureau of Statistics, 2013). This can be compared with 8% in Sudan as a whole (including Southern Sudan at that time; MoH & Southern Sudan Commission for Census, 2007) and 25% in SSA (UN, 2012). Access to family planning is strongly linked to gender equity, empowerment of women, education, and employment, and is a vital component to saving lives and preserving health through preventing untimely and unwanted pregnancies (United Nations Children’s Fund, 2012). Polygamy and polygyny are common in South Sudan, with 41% of all unions in 2010 being polygynous. Fewer than 10% of those in polygamous unions use safe sex practices (MoH & National Bureau of Statistics, 2013).

In Sudan (including Southern Sudan) in 2006, 36.4% of women received antenatal care (ANC) from a medical doctor, 12.7% from a nurse or midwife, and 14.5% from a traditional birth attendant. This contrasted with Southern Sudan at the same time, where only 9.8% of women received ANC from a medical doctor, 16.4% from a nurse or midwife, and 28.6% from a traditional birth attendant (MoH & Southern Sudan Commission for Census, 2007). Thus, only 26.2% of women in Southern Sudan received ANC by skilled health personnel in 2006; this increased to 40.3% in 2010; however, only 17% of women had the recommended 4 or more ANC visits (MoH & National Bureau of Statistics, 2013). Pregnancy outcomes in LMICs can be greatly improved through ANC (WHO, 2005).

The majority of maternal deaths occur during labor, delivery, and the immediate post-partum period, and as most are preventable, it is essential that a skilled health professional be available during childbirth. In Sudan as a whole, 49% of births were delivered by skilled personnel in 2006: doctors (6%), nurses or midwives (17%), and auxiliary midwives (26%). These figures are substantially lower in the states of Southern Sudan, with only 4% of deliveries being delivered by a doctor and 7% by nurses and midwives. In both Northern and Southern states, in 2006, traditional birth attendants assisted with 20% of births (MoH & Southern Sudan Commission for Census, 2007), which increased to 34% in South Sudan in 2010 (MoH & National Bureau of Statistics, 2013). In 2006, friends and family assisted in 16% of births in the North and 36% in the South (MoH & Southern Sudan Commission for Census, 2007).

The postnatal period is critical for mothers and newborns as they are at the highest risk of death during delivery and in the first hours and days following childbirth. Newborn survival is inextricably linked to the health and survival of the mother; thus, the early postnatal period is an important period for delivering integrated interventions to both. Postnatal care services from a skilled health care provider following delivery optimize mother and newborn health, promote healthy behaviors and healthy household practices, and strengthen linkages between maternal health and child health programs. Data on the postnatal period in South Sudan appear to be scarce.

A child born in South Sudan has a 25% chance of dying before age five (WHO, 2009); high mortality in under-fives is associated with pneumonia, malaria, and diarrheal diseases. Malnutrition is common: 27.6% of children below five are moderately or severely underweight and 12.2% severely underweight (MoH & National Bureau of Statistics, 2013). South Sudan has one of the lowest levels of immunization in the world (UNICEF, 2011), with some sources suggesting this has deteriorated over the past five years, whereas others suggest this results from variations in data collection and sampling. In 2010, only 4.3% of children aged 12 to 23 months had vaccination cards available, compared with around 13% in Southern Sudan in 2006. Measles vaccination coverage differed little between 2006 and 2010 (27.7% vs. 26.3%, respectively), as did the proportion of children who received all recommended vaccinations (2.7% in 2006 vs. 2.6% in 2010; MoH & National Bureau of Statistics, 2013).

Slowly recovering from the ravages of war and conflict, most of the targeted areas face certain peculiar challenges which include high maternal and infant mortality rates, disability rates, seasonal food insecurity which leads to malnutrition of both adults and children, high incidences of waterborne diseases and poor sanitation levels. In the circumstances, the place of Maternal, Child Health and Nutrition (MCHN) services cannot be underestimated. This is because women are at the centre of family life as caretakers of their husbands, children and members of the extended family. Children are a social investment for the future as they facilitate the sustainability of communities. Thus, access to superlative health services for both population categories is quintessential for improving socio-economic development. However, from the surveys that periodically conducted by CMC staff in the target areas, there is a poor MCHN services infrastructure that would guarantee the optimal survival of these population categories. One of the reasons noted was that there was lack of formal, well-equipped, Maternity Health Centres where pregnant and lactating mothers can get access to antenatal and postnatal health services, information on mother-to-child HIV transmission, breastfeeding, immunizations, family planning and nutrition. Most of the women deliver at home with the help of Traditional Birth Attendants (TBAs), thus exposing them to great risks during pregnancy, childbirth and while bringing up their newborns.

There also seems to be a weak connection between the existing formal health MCHN systems and the community-level structures. Indeed, community health structures such as TBAs, Community Health Volunteers (CHVs) and Village Health Teams (VHTs) seem to be undervalued and ignored by the formal system. This has resulted into the breakdown of MCHN service delivery to households in South Sudan. As a consequence, households also seem to have meager knowledge on Maternal, Child Health and Nutrition, hygiene and sanitation practices and little awareness of available services. Retrogressive cultural practices, beliefs and myths have also contributed a great haul to this challenge in the proposed project areas.

Again, while government policies generally exist for the provision of MCHN services, implementation of the same in the targeted areas have not been effective. As a result, many pregnant women end up losing their lives during childbirth. If they don’t lose their lives, they bring up malnourished children who also on account of missing out on important immunizations, end up being disabled or infected by communicable diseases. These interfere with their growth and threaten the future survival of the community. It is also notable that the potential use of mobile telephony services to scale-up the uptake of MCHN services in the target areas has also been greatly underutilized.

Our programme Objectives:
Objective 1 To improve access to quality Maternal, Child Health and Nutrition (MCHN) services for women and children domiciled in South Sudan.
Objective 2 To reduce neonatal and maternal mortality rates, and disability, within South Sudan Objective 3 To reduce the incidence, impact and severity of malnutrition amongst women and children within South Sudan.

Our Intervention Strategies:
To improve the prevailing state of Maternal Child Health and Nutrition (MCHN) services, CMC employs the following intervention strategies;

  • Construction of Maternity Health Centres with the support of like-minded donor organizations, that are equipped with the necessary equipment and supplies.
  • Ensuring adequate staffing of the Maternity Health Centres.
  • Conducting preliminary household surveys to identify pregnant women and lactating mothers who are in need of MCHN services. We also create records/registers of the same.
  • Training and advocacy on the benefits of institutional deliveries over home deliveries.
  • Using Appointment Diaries supplemented by Mobile Telephony Interventions (MTIs) to increase the uptake of institutional deliveries and to effectively track defaulters.
  • Enlisting the involvement of Traditional Birth Attendants (TBAs) inorder to induce both cultural and behavioural change.
  • Conducting Household Mapping Surveys to identify malnourished children, and developing records/registers of the affected children.
  • Establishment of Nutritional Education and Rehabilitation Centres (NERCs)
  • Provision of Community-based Home Care services for malnourished children.
  • Developing Food Composition Tables/Menus using locally available foodstuffs, and training women on cooking skills.
  • Distribution of foodstuffs to affected communities.